Tranexamic acid has been shown to be effective in reducing blood loss and transfusion in orthopedic surgery. It remains unknown the ideal therapeutic regimen. The goal of this study is to compare 3 dosage regimen of tranexamic acid in patients submitted to major orthopedic surgery.

There is ongoing debate, however, around optimal perioperative tranexamic acid dosing, which varies widely.

A large number of studies comparing tranexamic acid to placebo, overall blood loss and transfusion requirements are both reduced by ≈30%. A well designed tranexamic acid trial will provide answers to the best regimen dosage for perioperative tranexamic acid use. It will benefit patients by reducing allogeneic transfusions and their associated risks and costs, thus adding value to the care delivered.

Inclusion Criteria:

• Age ≥ 18 anos
• Total ankle arthroplasty
• Total knee arthroplasty
• Weight >50 kilogram

Exclusion Criteria:

• Allergy and Hypersensitivity to tranexamic acid
• Thromboembolic events history
• Epilepsy
• Acute kidney injury, Glomerular Filtration Rate < 50 ml/min
• Coagulation disorders
• Surgical reintervention
• Blood transfusion refusal

• Patients of a median size private hospital in Portugal